Question

Which assessment finding should the nurse interpret as indicative of agranulocytosis in a client taking clozapine (Clozaril)? a. Photosensitivity b. Tachycardia c. Low WBC d. Orthostatic hypotension

Short answer

Low WBC

Step-by-step solution

- Understand Agranulocytosis

Agranulocytosis is a severe condition characterized by a dangerously low number of granulocytes, a type of white blood cell (WBC), which leads to a weakened immune system.

- Identify the effects of Clozapine (Clozaril)

Clozapine is an antipsychotic medication often associated with severe side effects, including agranulocytosis. Regular blood tests are required to monitor WBC counts.

- Analyze the provided options

Review the options provided: a. Photosensitivity - sensitivity to light, not related to WBC count. b. Tachycardia - increased heart rate, unrelated to WBC count. c. Low WBC - directly affects the immune system and indicates agranulocytosis. d. Orthostatic hypotension - drop in blood pressure upon standing, also unrelated to WBC count.

- Determine the correct answer

Based on the understanding of agranulocytosis, the correct assessment finding indicative of agranulocytosis in a client taking clozapine is 'Low WBC.'

Key concepts

Agranulocytosis

Agranulocytosis is a serious condition marked by an extremely low level of granulocytes, a type of white blood cell crucial for fighting infections. When granulocyte levels drop too low, the body becomes highly susceptible to infections. This condition can be life-threatening and requires prompt medical attention to manage and treat any infections that arise. Symptoms of agranulocytosis include sudden fevers, chills, sore throat, and general weakness. Regular monitoring of white blood cell levels is essential for early detection and prevention of severe complications.

Clozapine side effects

Clozapine, marketed as Clozaril, is an antipsychotic medication used primarily for treating schizophrenia. Despite its effectiveness, clozapine is associated with several severe side effects, one of the most serious being agranulocytosis. Other side effects to be aware of include:

• Orthostatic hypotension: A significant drop in blood pressure upon standing
• Tachycardia: Increased heart rate
• Photosensitivity: Increased sensitivity to sunlight, leading to burns or rashes

Due to these potential side effects, patients on clozapine need regular monitoring and careful management to mitigate risks.

White blood cell count monitoring

Monitoring the white blood cell (WBC) count is crucial for patients taking clozapine. Regular blood tests are mandatory to detect any early signs of agranulocytosis. The schedule for blood tests usually includes:

• Weekly blood tests for the first six months of treatment
• Bi-weekly blood tests after the initial six months, if no issues are detected
• Monthly blood tests after one year of stable counts

Maintaining this monitoring schedule helps in promptly identifying drops in WBC counts, allowing for quick medical interventions to prevent severe complications.

Nursing assessment

A crucial part of nursing assessment for patients on clozapine therapy involves vigilant monitoring for any signs of agranulocytosis. Nurses should:

• Regularly check for symptoms like fever, sore throat, and general malaise which might indicate infections
• Keep track of the patient's WBC count through scheduled blood tests
• Educate patients on recognizing early signs of agranulocytosis and when to seek medical help
• Ensure patients understand the necessity of adhering to their blood test schedule

Effective nursing assessment and patient education can significantly reduce the risks associated with clozapine therapy, ensuring patient safety and well-being.